Michael Casey: Palliative care key to the future

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Nurses provide care to a patient in the palliative care unit of a hospital near Paris. Photo: CNS photo/Philippe Wojazer, Reuters
Nurses provide care to a patient in the palliative care unit of a hospital near Paris. Photo: CNS photo/Philippe Wojazer, Reuters

By Michael Casey

Tom Hobson hired out horses to travellers in Cambridge in the first half of the 1600s. We know his name today because of the choice he gave his customers: you could take the horse at the front of the line or none at all.

Choice is where you have an alternative. A Hobson’s choice is where you have none. Tom’s customers could still walk from Cambridge if they wanted to, but if you want to walk you don’t try to hire a horse.

Choice looms large in the arguments for euthanasia and assisted suicide, as the current debate about the legalisation of assisted dying in New South Wales reminds us. If Mr Greenwich’s bill becomes law, what sort of choice will there be for people who are approaching the end of their lives with a terrible disease, especially if they do not want to be assisted to die?

If they live in remote or outer regional New South Wales, the answer may well be Hobson’s choice. An analysis of health workforce data for 2013-20 from the New South Wales Department of Health suggests that in these areas there is not just a shortage of palliative care doctors and nurses in these areas, but in some cases none at all.

“… palliative care nurses increased significantly in inner regional and outer regional areas, but for most of those years it seems there were none  for residents in the remote parts of the state.”

The analysis, undertaken by the PM Glynn Institute at Australian Catholic University, highlights some stark findings. In the seven years to 2020, there was little improvement in the number of palliative care physicians resident in outer regional and remote areas. It seems that for most of those years, the number of palliative care physicians resident in these areas was zero.

Over the same period the number of palliative care nurses increased significantly in inner regional and outer regional areas, but for most of those years it seems there were none for residents in the remote parts of the state.

The workforce shortage in palliative care, particularly in outer regional and remote areas of New South Wales, raises serious questions about equity and access in the provision of palliative care. This is a significant problem in its own right.

Why is it that NSW is going straight to legalising euthanasia when it has not yet provided adequate palliative care desperately needed throughout the state? Photo: Pixabay
Why is it that NSW is going straight to legalising euthanasia when it has not yet provided adequate palliative care desperately needed throughout the state? Photo: Pixabay

It also raises serious questions about legalising euthanasia and assisted suicide in a situation where access to palliative care for those at the end of life or suffering from a life-limiting illness is neither universal nor equitable

Even with perfect choice and perfect provision and access to palliative care, there are a number of decisive reasons for opposing euthanasia and assisted suicide. Universal access to the best palliative care would not make euthanasia ok.

But if parliaments are going to consider legalising euthanasia, it should really only be after everything that can be done to ensure access to high-quality palliative care, including for people living in remote and outer regional areas, has been done. We are a long way from anything like this.

The New South Wales bill places a strong emphasis on choice, and some amendments have helped to raise the importance of access to palliative care.

“… the next logical step is to significantly improve access to good palliative care. In fact, we should be aiming for universal access in our state.”

The bill now states that people in regional areas should have the same level of access to palliative care as people in the major cities. The more important focus for the bill, however, is that people in the regions have the same level of access to assisted dying. If people in regional areas do in fact attain the same level of access to euthanasia as people in the cities, without also having the same level of access to palliative care, can this really be described as a choice?

People everywhere in New South Wales have a right to high-quality palliative care. Everyone wants to improve the quality of care received by people with a chronic illness or who are approaching the end of life, and everyone agrees that people in remote and outer regional areas should not be left out. So the next logical step is to significantly improve access to good palliative care. In fact, we should be aiming for universal access in our state.

It is a big jump to go straight to assisted dying when there’s a long way to go in making sure everyone who needs high quality palliative has access to it.

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